Multicenter Study

. 2025 Apr;25(4):848-859.

doi: 10.1016/j.ajt.2024.10.020. Epub 2024 Nov 9.

Carbapenem-resistant Enterobacterales in solid organ transplant recipients

Angelique E Boutzoukas¹, Weixiao Dai², Eric Cober³, Lilian M Abbo⁴, Lauren Komarow², Liang Chen⁵, Carol Hill⁶, Michael J Satlin⁷, Matthew Grant⁸, Bettina C Fries⁹, Gopi Patel¹⁰, Todd P McCarty¹¹, Cesar A Arias¹², Robert A Bonomo¹³, David van Duin¹⁴; Antibacterial Resistance Leadership Group and the MDRO Network Investigators

Collaborators, Affiliations

Collaborators

Antibacterial Resistance Leadership Group and the MDRO Network Investigators:
Souha S Kanj¹⁵, Jean Francois Jeff Jabbour¹⁵, Fujie Zhang¹⁶, Judith J Lok¹⁷, Robert A Salata¹⁸, Martin Stryjewski¹⁹, Valentina Di Castelnuovo¹⁹, Jose Millan Oñate Gutierrez²⁰, Eric Cober²¹, Susan Richter²¹, Deverick J Anderson²², Beth Evans²², Carol Hill²², Heather R Cross²², Keri Baum²², Rebekka Arias²², Vance G Fowler Jr²², Karen Ordoñez²³, Jesse T Jacob²⁴, Linghua Li²⁵, Barry N Kreiswirth²⁶, Claudia Manca²⁶, Liang Chen²⁶, Samit Desai²⁶, Erica Herc²⁷, Ezequiel Cordova²⁸, Maria Rioseco²⁹, Samuel Vichez³⁰, Marisa L Sanchez³¹, Sandra Valderrama³², Jairo Figueroa³³, Cesar A Arias³⁴, An Q Dinh³⁴, Diane Panesso³⁴, Kirsten Rydell³⁴, Truc T Tran³⁴, Fupin Hu³⁵, Jiachun Su³⁵, Jianping Jiang³⁵, Minggui Wang³⁵, Xiaogang Xu³⁵, Yang Yang³⁵, Jose M Munita³⁶, Maria Spencer³⁶, Thamer Alenazi³⁷, Robert A Bonomo³⁸, Steven H Marshall³⁸, Susan D Rudin³⁸, Charles Huskins³⁹, Kerry³⁹, Robin Patel⁴⁰, Suzannah Schmidt-Malan⁴⁰, Sara Revolinski⁴¹, Glenn Wortmann⁴², Robert C Kalayjian⁴³, Greg Weston⁴⁴, Belinda Ostrowsky⁴⁵, Gopi Patel⁴⁶, Daniel Eiras⁴⁷, Angela Kim⁴⁸, Julia Garcia-Diaz⁴⁹, Soraya Salcedo⁵⁰, John J Farrell⁵¹, Zhengyin Liu⁵², Andrew Henderson⁵³, David L Paterson⁵⁴, Qing Xie⁵⁵, Keith S Kaye⁵⁶, Hainv Gao⁵⁷, Yunsong Yu⁵⁸, Mary Waters⁵⁹, Bettina C Fries⁶⁰, Brandon Eilertson⁶¹, Kalisvar Marimuthu⁶², Kean Lee Chew⁶², Nares Smitasin⁶², Paul Ananth Tambyah⁶², Jason C Gallagher⁶³, Anton Peleg⁶⁴, Marcel Leroi⁶⁵, Lanjuan Li⁶⁶, Lauren Komarow⁶⁷, Lizhao Ge⁶⁷, Scott Evans⁶⁷, Todd McCarty⁶⁸, Henry F Chambers⁶⁹, Omai B Garner⁷⁰, Lilian M Abbo⁷¹, David van Duin⁷², Ebbing Lautenbach⁷³, Jennifer H Han⁷³, Yohei Doi⁷⁴, Darren Wong⁷⁵, Blake Hanson⁷⁶, Jinnethe Reyes⁷⁷, Maria Virginia Villegas Botero⁷⁷, Lorena Diaz⁷⁷, Federico Perez⁷⁸, Ritu Banerjee⁷⁹, Sorabh Dhar⁸⁰, Michael J Satlin⁸¹, Zhiyong Zong⁸²

Affiliations

¹ Department of Pediatrics, Duke University, Durham, North Carolina, USA; Duke Clinical Research Institute, Durham, North Carolina, USA.
² The Biostatistics Center, The George Washington University, Rockville, Maryland, USA.
³ Department of Infectious Diseases, Cleveland Clinic, Cleveland, Ohio, USA.
⁴ Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine and Jackson Health System, Miami, Florida, USA.
⁵ Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, New Jersey, USA.
⁶ Duke Clinical Research Institute, Durham, North Carolina, USA.
⁷ Division of Infectious Diseases, Weill Cornell Medicine, NewYork-Presbyterian Hospital, New York, New York, USA.
⁸ Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA.
⁹ Division of Infectious Diseases, Department of Medicine, Stony Brook University, Stony Brook, New York, USA.
¹⁰ Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
¹¹ Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama, USA.
¹² Division of Infectious Diseases, Houston Methodist Hospital, Houston, Texas, USA; Center for Infectious Diseases Research at Houston Methodist Research Institute, Houston, Texas, USA; Department of Medicine, Weill Cornell Medical College, New York, New York, USA.
¹³ Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio, USA; Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA; Department of Pharmacology, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA; Department of Molecular Biology and Microbiology, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA; Department of Biochemistry, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA; Department of Proteomics and Bioinformatics, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA; Case Western Reserve University-Cleveland Veterans Affairs Medical Center for Antimicrobial Resistance and Epidemiology (Case Veterans Affairs Center for Antimicrobial Resistance and Epidemiology), Cleveland, Ohio, USA.
¹⁴ Division of Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina, USA. Electronic address: David_vanduin@med.unc.edu.
¹⁵ American University of Beirut Medical Center, Beirut, Lebanon.
¹⁶ Beijing Ditan Hospital, Capital Medical University, Beijing, China.
¹⁷ Boston University, Boston, MA, USA.
¹⁸ Case Western, Cleveland, OH, USA.
¹⁹ Centro de Educacion Medica e Investigaciones Clinicas, Buenos Aires, Argentina.
²⁰ Centro Medico Imbanaco, Cali, Colombia.
²¹ Cleveland Clinic, Cleveland, OH, USA.
²² Duke University, Durham, NC, USA.
²³ E.S.E Hospital Universitario, San Jorge de Pereira, Pereira, Colombia.
²⁴ Emory University, Atlanta, GA, USA.
²⁵ Guangzhou Eighth People's Hospital, Guangzhou, China.
²⁶ Hackensack Meridian Health, Nutley, NJ, USA.
²⁷ Henry Ford Hospital, Detroit, MI, USA.
²⁸ Hospital "Cosme Argerich" de Buenos Aires, Buenos Aires, Argentina.
²⁹ Hospital de Puerto Montt, Puerto Montt, Chile.
³⁰ Hospital Escuela Oscar Danilo Rosales Arguello, Leon, Nicaragua.
³¹ Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
³² Hospital San Ignacio, Bogots, Colombia.
³³ Hospital Universitario Erasmo Meoz ESE, Cucuta, Colombia.
³⁴ Houston Methodist, Houston, TX, USA.
³⁵ Huashan Hospital, Fudan University, Shanghai, China.
³⁶ Instituto de Ciencias e Innovacion en Medicina, Clinica Alemana, Universidad del Desarrollo, Santiago, Chile.
³⁷ King Abdulaziz Medical City, Riyadh, Saudi Arabia.
³⁸ Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH, USA.
³⁹ Mayo Clinic, Rochester, MN, USA.
⁴⁰ Greenwood-Quaintance.
⁴¹ Medical College of Wisconsin, Milwaukee, WI, USA.
⁴² MedStar Washington Hospital Center, Washington, DC, USA.
⁴³ MetroHealth Medical Center, Cleveland, OH, USA.
⁴⁴ Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY, USA.
⁴⁵ Montefiore Medical Center, Moses Campus, Bronx, NY, USA.
⁴⁶ Mount Sinai, New York, NY, USA.
⁴⁷ New York University Langone Medical Center, NY, USA.
⁴⁸ North Shore University Hospital, Manhasset, NY, USA.
⁴⁹ Ochsner Clinic Foundation, New Orleans, LA, USA.
⁵⁰ Organizacion Clinica General del Norte, Barranquilla, Colombia.
⁵¹ OSF Saint Francis Medical Center, Peoria, Illinois, USA.
⁵² Peking Union Medical College Hospital, Beijing, China.
⁵³ Princess Alexandra Hospital, Brisbane, Queensland, Australia.
⁵⁴ Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.
⁵⁵ Ruijin Hospital, Shanghai Jiaotong University, Shanghai, China.
⁵⁶ Rutgers University, New Brunswick, NJ, USA.
⁵⁷ Shulan Hangzhou Hospital, Shulan Health, Hangzhou, China.
⁵⁸ Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China.
⁵⁹ St Vincent's Hospital, Melbourne, VIC, Australia.
⁶⁰ Stony Brook University, Stony Brook, NY, USA.
⁶¹ SUNY Downstate Medical Center, New York, NY, USA.
⁶² Tan Tock Seng Hospital, Singapore.
⁶³ Temple University Hospital, Philadelphia, PA, USA.
⁶⁴ The Alfred Hospital, Melbourne, VIC, Australia.
⁶⁵ The Austin Hospital, Heidelberg West, Victoria, Australia.
⁶⁶ The First Affiliated Hospital of Medical School of Zhejiang University, Hangzhou, China.
⁶⁷ The George Washington University, Washington, DC, USA.
⁶⁸ The University of Alabama, Birmingham, AL, USA.
⁶⁹ The University of California San Francisco, CA, USA.
⁷⁰ The University of California, Los Angeles, CA, USA.
⁷¹ The University of Miami Miller School of Medicine and Jackson Health System, Miami, FL, USA.
⁷² The University of North Carolina, Chapel Hill, NC, USA.
⁷³ The University of Pennsylvania Health System, Philadelphia, PA, USA.
⁷⁴ The University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
⁷⁵ The University of Southern California, Los Angeles, CA, USA.
⁷⁶ The University of Texas Health Science Center at Houston, Houston, TX, USA.
⁷⁷ Universidad El Bosque, Bogota, Colombia.
⁷⁸ University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
⁷⁹ Vanderbilt University Medical Center, Nashville, TN, USA.
⁸⁰ Wayne State University, Detroit, MI, USA.
⁸¹ Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY, USA.
⁸² West China Hospital of Sichuan University, Chengdu, China.

PMID: 39522694
PMCID: PMC11997972
DOI: 10.1016/j.ajt.2024.10.020

Multicenter Study

Carbapenem-resistant Enterobacterales in solid organ transplant recipients

Angelique E Boutzoukas et al. Am J Transplant. 2025 Apr.

. 2025 Apr;25(4):848-859.

doi: 10.1016/j.ajt.2024.10.020. Epub 2024 Nov 9.

Authors

Collaborators

Antibacterial Resistance Leadership Group and the MDRO Network Investigators:
Souha S Kanj¹⁵, Jean Francois Jeff Jabbour¹⁵, Fujie Zhang¹⁶, Judith J Lok¹⁷, Robert A Salata¹⁸, Martin Stryjewski¹⁹, Valentina Di Castelnuovo¹⁹, Jose Millan Oñate Gutierrez²⁰, Eric Cober²¹, Susan Richter²¹, Deverick J Anderson²², Beth Evans²², Carol Hill²², Heather R Cross²², Keri Baum²², Rebekka Arias²², Vance G Fowler Jr²², Karen Ordoñez²³, Jesse T Jacob²⁴, Linghua Li²⁵, Barry N Kreiswirth²⁶, Claudia Manca²⁶, Liang Chen²⁶, Samit Desai²⁶, Erica Herc²⁷, Ezequiel Cordova²⁸, Maria Rioseco²⁹, Samuel Vichez³⁰, Marisa L Sanchez³¹, Sandra Valderrama³², Jairo Figueroa³³, Cesar A Arias³⁴, An Q Dinh³⁴, Diane Panesso³⁴, Kirsten Rydell³⁴, Truc T Tran³⁴, Fupin Hu³⁵, Jiachun Su³⁵, Jianping Jiang³⁵, Minggui Wang³⁵, Xiaogang Xu³⁵, Yang Yang³⁵, Jose M Munita³⁶, Maria Spencer³⁶, Thamer Alenazi³⁷, Robert A Bonomo³⁸, Steven H Marshall³⁸, Susan D Rudin³⁸, Charles Huskins³⁹, Kerry³⁹, Robin Patel⁴⁰, Suzannah Schmidt-Malan⁴⁰, Sara Revolinski⁴¹, Glenn Wortmann⁴², Robert C Kalayjian⁴³, Greg Weston⁴⁴, Belinda Ostrowsky⁴⁵, Gopi Patel⁴⁶, Daniel Eiras⁴⁷, Angela Kim⁴⁸, Julia Garcia-Diaz⁴⁹, Soraya Salcedo⁵⁰, John J Farrell⁵¹, Zhengyin Liu⁵², Andrew Henderson⁵³, David L Paterson⁵⁴, Qing Xie⁵⁵, Keith S Kaye⁵⁶, Hainv Gao⁵⁷, Yunsong Yu⁵⁸, Mary Waters⁵⁹, Bettina C Fries⁶⁰, Brandon Eilertson⁶¹, Kalisvar Marimuthu⁶², Kean Lee Chew⁶², Nares Smitasin⁶², Paul Ananth Tambyah⁶², Jason C Gallagher⁶³, Anton Peleg⁶⁴, Marcel Leroi⁶⁵, Lanjuan Li⁶⁶, Lauren Komarow⁶⁷, Lizhao Ge⁶⁷, Scott Evans⁶⁷, Todd McCarty⁶⁸, Henry F Chambers⁶⁹, Omai B Garner⁷⁰, Lilian M Abbo⁷¹, David van Duin⁷², Ebbing Lautenbach⁷³, Jennifer H Han⁷³, Yohei Doi⁷⁴, Darren Wong⁷⁵, Blake Hanson⁷⁶, Jinnethe Reyes⁷⁷, Maria Virginia Villegas Botero⁷⁷, Lorena Diaz⁷⁷, Federico Perez⁷⁸, Ritu Banerjee⁷⁹, Sorabh Dhar⁸⁰, Michael J Satlin⁸¹, Zhiyong Zong⁸²

Affiliations

¹ Department of Pediatrics, Duke University, Durham, North Carolina, USA; Duke Clinical Research Institute, Durham, North Carolina, USA.
² The Biostatistics Center, The George Washington University, Rockville, Maryland, USA.
³ Department of Infectious Diseases, Cleveland Clinic, Cleveland, Ohio, USA.
⁴ Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine and Jackson Health System, Miami, Florida, USA.
⁵ Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, New Jersey, USA.
⁶ Duke Clinical Research Institute, Durham, North Carolina, USA.
⁷ Division of Infectious Diseases, Weill Cornell Medicine, NewYork-Presbyterian Hospital, New York, New York, USA.
⁸ Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA.
⁹ Division of Infectious Diseases, Department of Medicine, Stony Brook University, Stony Brook, New York, USA.
¹⁰ Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
¹¹ Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama, USA.
¹² Division of Infectious Diseases, Houston Methodist Hospital, Houston, Texas, USA; Center for Infectious Diseases Research at Houston Methodist Research Institute, Houston, Texas, USA; Department of Medicine, Weill Cornell Medical College, New York, New York, USA.
¹³ Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio, USA; Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA; Department of Pharmacology, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA; Department of Molecular Biology and Microbiology, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA; Department of Biochemistry, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA; Department of Proteomics and Bioinformatics, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA; Case Western Reserve University-Cleveland Veterans Affairs Medical Center for Antimicrobial Resistance and Epidemiology (Case Veterans Affairs Center for Antimicrobial Resistance and Epidemiology), Cleveland, Ohio, USA.
¹⁴ Division of Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina, USA. Electronic address: David_vanduin@med.unc.edu.
¹⁵ American University of Beirut Medical Center, Beirut, Lebanon.
¹⁶ Beijing Ditan Hospital, Capital Medical University, Beijing, China.
¹⁷ Boston University, Boston, MA, USA.
¹⁸ Case Western, Cleveland, OH, USA.
¹⁹ Centro de Educacion Medica e Investigaciones Clinicas, Buenos Aires, Argentina.
²⁰ Centro Medico Imbanaco, Cali, Colombia.
²¹ Cleveland Clinic, Cleveland, OH, USA.
²² Duke University, Durham, NC, USA.
²³ E.S.E Hospital Universitario, San Jorge de Pereira, Pereira, Colombia.
²⁴ Emory University, Atlanta, GA, USA.
²⁵ Guangzhou Eighth People's Hospital, Guangzhou, China.
²⁶ Hackensack Meridian Health, Nutley, NJ, USA.
²⁷ Henry Ford Hospital, Detroit, MI, USA.
²⁸ Hospital "Cosme Argerich" de Buenos Aires, Buenos Aires, Argentina.
²⁹ Hospital de Puerto Montt, Puerto Montt, Chile.
³⁰ Hospital Escuela Oscar Danilo Rosales Arguello, Leon, Nicaragua.
³¹ Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
³² Hospital San Ignacio, Bogots, Colombia.
³³ Hospital Universitario Erasmo Meoz ESE, Cucuta, Colombia.
³⁴ Houston Methodist, Houston, TX, USA.
³⁵ Huashan Hospital, Fudan University, Shanghai, China.
³⁶ Instituto de Ciencias e Innovacion en Medicina, Clinica Alemana, Universidad del Desarrollo, Santiago, Chile.
³⁷ King Abdulaziz Medical City, Riyadh, Saudi Arabia.
³⁸ Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH, USA.
³⁹ Mayo Clinic, Rochester, MN, USA.
⁴⁰ Greenwood-Quaintance.
⁴¹ Medical College of Wisconsin, Milwaukee, WI, USA.
⁴² MedStar Washington Hospital Center, Washington, DC, USA.
⁴³ MetroHealth Medical Center, Cleveland, OH, USA.
⁴⁴ Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY, USA.
⁴⁵ Montefiore Medical Center, Moses Campus, Bronx, NY, USA.
⁴⁶ Mount Sinai, New York, NY, USA.
⁴⁷ New York University Langone Medical Center, NY, USA.
⁴⁸ North Shore University Hospital, Manhasset, NY, USA.
⁴⁹ Ochsner Clinic Foundation, New Orleans, LA, USA.
⁵⁰ Organizacion Clinica General del Norte, Barranquilla, Colombia.
⁵¹ OSF Saint Francis Medical Center, Peoria, Illinois, USA.
⁵² Peking Union Medical College Hospital, Beijing, China.
⁵³ Princess Alexandra Hospital, Brisbane, Queensland, Australia.
⁵⁴ Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.
⁵⁵ Ruijin Hospital, Shanghai Jiaotong University, Shanghai, China.
⁵⁶ Rutgers University, New Brunswick, NJ, USA.
⁵⁷ Shulan Hangzhou Hospital, Shulan Health, Hangzhou, China.
⁵⁸ Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China.
⁵⁹ St Vincent's Hospital, Melbourne, VIC, Australia.
⁶⁰ Stony Brook University, Stony Brook, NY, USA.
⁶¹ SUNY Downstate Medical Center, New York, NY, USA.
⁶² Tan Tock Seng Hospital, Singapore.
⁶³ Temple University Hospital, Philadelphia, PA, USA.
⁶⁴ The Alfred Hospital, Melbourne, VIC, Australia.
⁶⁵ The Austin Hospital, Heidelberg West, Victoria, Australia.
⁶⁶ The First Affiliated Hospital of Medical School of Zhejiang University, Hangzhou, China.
⁶⁷ The George Washington University, Washington, DC, USA.
⁶⁸ The University of Alabama, Birmingham, AL, USA.
⁶⁹ The University of California San Francisco, CA, USA.
⁷⁰ The University of California, Los Angeles, CA, USA.
⁷¹ The University of Miami Miller School of Medicine and Jackson Health System, Miami, FL, USA.
⁷² The University of North Carolina, Chapel Hill, NC, USA.
⁷³ The University of Pennsylvania Health System, Philadelphia, PA, USA.
⁷⁴ The University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
⁷⁵ The University of Southern California, Los Angeles, CA, USA.
⁷⁶ The University of Texas Health Science Center at Houston, Houston, TX, USA.
⁷⁷ Universidad El Bosque, Bogota, Colombia.
⁷⁸ University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
⁷⁹ Vanderbilt University Medical Center, Nashville, TN, USA.
⁸⁰ Wayne State University, Detroit, MI, USA.
⁸¹ Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY, USA.
⁸² West China Hospital of Sichuan University, Chengdu, China.

PMID: 39522694
PMCID: PMC11997972
DOI: 10.1016/j.ajt.2024.10.020

Abstract

Carbapenem-resistant Enterobacterales (CRE) are an important threat to the health of solid organ transplant recipients (SOTr); data comparing outcomes of SOTr with CRE to non-SOTr with CRE are lacking. A matched cohort study was performed within 2 prospective, multicenter, cohort studies (Consortium on Resistance Against Carbapenems in Klebsiella and other Enterobacterales and Consortium on Resistance Against Carbapenems in Klebsiella and other Enterobacterales 2). The epidemiology, desirability of outcome rankings outcomes, and mortality of SOTr and non-SOTr hospitalized in the United States (December 2011-August 2017) with clinical isolates with Centers for Disease Control and Prevention-defined CRE were compared. In total, 121 SOTr and 242 matched non-SOTr were included. Fifty-one percent of isolates met infection criteria. SOTr were younger (P < .001), less acutely ill (P = .029), less often had a malignancy history (P = .006), and more often were admitted from home (P < .001) than non-SOTr. SOTr had more favorable adjusted desirability of outcome rankings outcomes; a randomly selected SOTr had a 58% (95% confidence interval, 53%-64%) probability of a better outcome as compared to a randomly selected non-SOTr. All-cause 30-day mortality was 14% (17/121) in SOTr vs 25% (60/242) in non-SOTr, P = .018. After stabilized inverse probability weighted adjustment, SOTr had a 7% lower 30-day mortality risk than non-SOTr (95% confidence interval, -15% to 1%). SOTr with CRE do not have worse outcomes than matched patients without transplant history.

Keywords: carbapenem-resistant Enterobacterales; epidemiology; mortality; solid organ transplantation.

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Conflict of interest statement

Declaration of competing interest The authors of this manuscript have conflicts of interest to disclose as described by American Journal of Transplantation. All authors report funding support from the ARLG of the National Institutes of Health (NIH) and the National Institute of Allergy and Infectious Diseases (NIAID; UM1AI104681) during the conduct of this study. W. Dai, E. Cober, L. Komarow, L. Chen, C. Hill, M. Grant, and G. Patel have nothing to declare other than the ARLG grant paid to their institution. A.E. Boutzoukas reports NIH grants and contracts paid to her institution, research support from the Thrasher Research Foundation, and support from the Biogen Foundation. L.M. Abbo reports honorarium for ontinuing medical education (CM lectures from Pfizer Latin America and Merck Sharp & Dohme Latin America related to the study; and in the last 3 years consulting honorarium from bioMéreiux, Shionogi, Ferring pharmaceuticals, Pfizer, La Joya, Abbvie Therapeutics; and speaker honorarium for CME lectures from Medscape and Clinical Care options. M.J. Satlin reports grants/contracts to his institution from Merck, Selux Diagnostics, SNIPRBiome, and bioMéreiux; consulting fees paid directly to him from Shionogi; and compensation for participation on a data and safety monitoring board from AbbVie paid directly to him. B.C. Fries reports support from the USVeterans Affairs Merit Review Award 5I01 BX003741 and the National Institute for Allergy Infectious Diseases R01AI181830; is an attending at the US Department of Veterans Affairs, Northport Veterans Affairs (VA) Medical Center, Northport, NY; contents of this review do not represent the views of the VA or the United States Government. T.P. McCarty reports a research contract paid to his institution from T2Biosystems. C.A. Arias reports the following grants and contracts paid to his institution NIH/NIAID 1 P01 AI152999, NIH/NIAID R01 AI148342, NIH/NIAID R01 AI134637, NIH/NIAID T32 AI141349, NIH/NIAID K24 AI121296, NIH/NIAID U19 AI144297, and NIH/NIAID R01 AI150685; payments to him for UpToDate royalties; reimbursement of meeting attendance and speaking from Infectious Diseases Society of America, American Society for Microbiology, Society of Hospital Epidemiology of America, European Society for Clinical Microbiology and Infectious Diseases, Mérieux Foundation, Sociedad Argentina de Infectologia, Sociedad Chilena de Infectologia, Sociedad Colombiana de Infectologia, Panamerican Society for Infectious Diseases, and Brazilian Society for Infectious Diseases; reviewer participation as part of the NIH grant Review Study Sections; travel expenses from the Infectious Disease Society of America Board of Directors; and for Editor in Chief for Antimicrobial Agents and Chemotherapy; nonpaid participation includes World Health Organization Antibacterial Pipeline Advisory Group, and participation on the Infectious Disease Society of America Board of Directors. R.A. Bonomo reports grants and contracts, paid to his institution, by VenatoRx and Merck; payments made to him by Pfizer to moderate meeting sessions; a provisional patent with Case Western Reserve University on the development of boronic acid transition state inhibitors for beta-lactamases; served on a data and safety monitoring board as a logistics associate for Division of Microbiology and Infectious Diseases-Clinical Research Operations and Management Support, Safety Oversight Committee Support; and Technical Resources International, Inc. D. van Duin reports grants and contracts from the NIH, Merck, and Shinogi, paid to his institution, outside of the published work; consultancy for Actavis, Tetraphase, Sanofi-Pasteur, MedImmune, Astellas, Merck, Allergan, T2Biosystems, Roche, Achaogen, Neumedicine, Shionogi, Pfizer, Entasis, Qpex, Wellspring, Karius, and Utility, paid directly to him; honoraria from Pfizer; and an editor’s stipend from the British Society for Antimicrobial Chemotherapy.

Figures

**Figure 1:. Phylogenetic population structure of *Klebsiella pneumoniae* isolates from CRACKLE and CRACKLE-2 (n=216)**
SOT, solid organ transplantation; CGs, clonal groups, DOOR, desirability of outcome ranking. The corresponding metadata indicate solid organ transplant status (recipient versus non-recipient), geographical region, clonal group, carbapenemase genes, and 3-category DOOR index 30-days after culture. Events analyzed for DOOR analysis included failure to discharge home and incident renal failure.

See this image and copyright information in PMC

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Carbapenem-resistant Enterobacterales in solid organ transplant recipients

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Carbapenem-resistant Enterobacterales in solid organ transplant recipients

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